Mattie Lou Koster, 1912-2001
QUESTIONS AND ANSWERS
MEDICAL ADVISORY BOARD
What are the early symptoms of benign
Botox ® (onabotulinumtoxinA)
Mark Hallett, M.D., Chair . . . . . Bethesda, MD
Xeomin ® (incobotulinumtoxinA)
Brian D. Berman, M.D., M.S. . . . . .Denver, CO
• Dry eyes
Dysport ® (abobotulinumtoxinA)
L. Craig Evinger, Ph.D. . . . . . Stony Brook, NY
• Light sensitivity
Myobloc ® (rimabotulinumtoxinB)
Andrew Harrison, M.D. . . . . Minneapolis, MN
• Occasional increased blinking,
winking or squinting
What is the procedure for a botulinum toxin
Joseph Jankovic, M.D. . . . . . . .Houston, TX
• First symptoms are often noticed when driving
treatment and what results should I expect?
Laurie J. Ozelius, Ph.D. . . . . . .New York, NYJames R. Patrinely, M.D. . . . . . .Houston, TX
How do the symptoms of benign essential
Using a very fine needle, several injections of
botulinum toxin are made around the eyes
and Pensacola, FL
blepharospasm or oromandibular dystonia
directly into muscles that are contracting
Alan B. Scott, M.D. . . . . . .San Francisco, CA
excessively. Positive effects of the treatment for
Mark Stacy, M.D. . . . . . . . . .Durham, NC
blepharospasm are often seen within about 3
Edwardo Tolosa, M.D. . . . . . Barcelona, Spain
• Increased blinking, squinting,
days of botulinum toxin treatment and the
or forced eyelid closure
maximum effect is often achieved 2-3 weeks
• Eyelids clamp shut and eyebrows pul down
DISTRICT DIRECTORS & E-MAIL
after injection. Results from one treatment can
• Symptoms may become so severe that the
last up to 3 months.
Shelley Goddard, North Central
patient becomes functional y blind
IL, IN, IA, KY, MI, MN, NE, OH, SD, WI, ND
• May develop lower facial problems such as
Wil botulinum toxin injections make it
grimacing of the mouth
possible for me to perform activities as before
the onset of blepharospasm/Meige?
Peter Bakalor, Western
• May develop breathing problems
AK, AZ, CA, CO, HI, ID, MT, NV,
What type of doctor treats blepharospasm?
It's hard to say. The severity of blepharospasm
NM, OR, UT, WA, WY
and the response to botulinum toxin treatment is
Neurologists, neuro-ophthalmologists, ophthal-
not the same for everyone.
mologists and oculoplastic surgeons. However,
Barbara Benton, Eastern
look for one that treats blepharospasm and has
Is a botulinum toxin treatment painful?
CT, DE, DC, MA, MD, ME, NH, NJ, NY,
experience injecting botulinum toxin.
There can be momentary pain during each injec-
NC, PA, PR, RI, SC, VT, VA, WV
tion. Some are bothered by the pain more than
What treatments are available for benign
others. EMLA cream (a prescription topical anes-
thetic) can be placed on the area approximately
Fran Morgan, Southern
1-1/2 hours prior to injection and may be helpful.
AL, AR, FL, GA, KS, LA, MS, MO, OK, TN, TX
• Botulinum toxin injections
A cold compress (or a bag of frozen peas) applied
• Medical (drug) treatment
to the injection site before the injections may also
• Surgery (myectomy)
For further information, contact:
What is botulinum toxin?
What is the usual botulinum toxin dosage?
BENIGN ESSENTIAL BLEPHAROSPASM
Eyelid muscle spasms
Botulinum toxin is currently the treatment of
There is not a standard dose as each patient is
choice for blepharospasm. When injected into
different, the types of dystonia vary, and botulinum
P. O. Box 12468 • Beaumont, TX 77726-2468, USA
muscles, it temporarily weakens them. It is
toxin comes in various forms. Most physicians start
• Oromandibular Dystonia
(409) 832-0788 • Fax (409) 832-0890
approved for use in over 60 countries.
injecting with a low dosage to avoid possible side
Blepharospasm patients in the U.S. are
effects, increasing it as needed. If the first set of
currently injected with the fol owing FDA
injections is not satisfactory, the physician should
BEBRF is an exempt organization under Section 501(C)(3).
Lower facial and jaw spasms
approved botulinum toxins:
be notified so that he/she can personalize the
All donations are tax deductible.
See table in next column
treatments to suit the individual patient.
Revised December 2013
What are the possible side effects of botulinum
Injections should be covered (to some extent)
The fol owing drugs are helpful to some when
Can benign essential blepharospasm be
by Medicare and private insurance. Through
used in conjunction with injections. This is not a
their Patient Assistance Programs, Al ergan
• Temporary drooping of the eyelids (ptosis)
(BOTOX®/ onabotulinumtoxinA), Merz Pharma-
• A gene for blepharospasm has NOT been
may partial y obscure vision
ceuticals, LLC (Xeomin®/ incobotulinumtoxinA),
Brand Name Drug Type
• Eye irritation, dry eyes, tearing, or light
and Solstice Neurosciences (Myobloc®/
• 5% of patients with blepharospasm have
rimabotulinumtoxinB) are dedicated to
family members that have facial movement
• Occasional blurry or double vision
supporting patients who are subject to
disorders (95% don't).
• Side effects are usual y mild and short in
financial hardships. Some of the Patient
• It is possible that there may be some
Assistance Programs do not apply to patients
"predisposition" for blepharospasm that can be
inherited, but it has not been identified.
What should I do if I'm not getting good results
on Medicare. For information, contact:
from my botulinum toxin treatment?
Al ergan (BOTOX®/ onabotulinumtoxinA) Botox Pa-
Is it possible for someone with benign essential
blepharospasm to have a spontaneous remission?
Discuss it with your injecting physician. A
tient Assistance Program (uninsured and underinsured)
change of sites or dosage may be needed. If
• Phone: 1-800-442-6869 from 9am to 8pm (ET),
BEBRF does not advocate any particular drug
Complete remissions have been reported but they
he/she is not wil ing to work with you, or if after
Monday thru Friday
treatment option; therefore, it is strongly sug-
are rare. Sometimes temporary remission occurs.
several attempts at solving the issues, you're
gested that patients do not change medications
stil not satisfied, you may need to go to a
without first consulting with their physician.
Is benign essential blepharospasm a psychiatric
Merz Pharmaceuticals, LLC (Xeomin®/
Are there drugs that may make
Is there anything I can do to make the
incobotulinumtoxinA) Patient Assistance Pro-
No! It is a neurological disorder. It is sometimes
misdiagnosed as a psychiatric disorder.
botulinum toxin treatment more effective?
gram (uninsured) and Patient
Co-Pay Program (co-pay assistance)
There are some drugs belonging to a class cal ed
Keep a diary with the fol owing information:
What can I do to help relieve dry eye
• Phone: 1-888-493-6646 from 8 am to 8 pm
"dopamine receptor blocking agents" (DRBAs)
(ET), Monday thru Friday
that may aggravate blepharospasm and lower
•Number of units
• Online for Patient Co-Pay Program only:
facial and jaw spasms.
It may take some experimenting to find out
•When it kicked in
Wil my insurance company pay for
what works for you.
• Artificial tears
Solstice Neurosciences (Myobloc®/
•How long it lasted
• Moisturizing gels or ointments
rimabotulinumtoxinB) Patient Reimbursement
Communicate honestly with your doctor.
• Warm or cold compresses on the eyes
Program (financial hardship)
Before proceeding with this treatment option,
check with your insurance company to be sure that
• Fish oil or flaxseed oil supplements
What are some reasons for having unsuccessful
• Phone: 1-888-461-2255, 9am to 6pm (ET),
they wil pay for it. If not covered by insurance, the
results from botulinum toxin injections?
Monday thru Friday
ful out-of-pocket cost for a myectomy may be sur-
• Dr. Soparkar's video under "Dry Eyes and
• Incorrect reconstitution of the toxin
prisingly high and may vary from facility to facility.
What are some things you can do to relieve the
• Insufficient dosage
Do any drugs help benign essential
symptoms of benign essential
I need to apply for disability. What should I do?
• Injection site selection
• Injection technique
Drugs used to treat benign essential
BEBRF has a packet of material available at no
• Apraxia of eyelid opening (inability to keep
blepharospasm require a prescription and
• Wear sunglasses (type that wrap around to cut
charge for those patients who are considering
eyelid open in absence of spasms)
physician supervision. It requires trial and error to
filing for Disability under the Social Security Act.
Can I develop antibodies from botulinum toxin
find a drug that helps. Some of these drugs may
• Wear a hat with a brim
This packet does not include disability
have severe side effects, may lose effectiveness
• Sit facing away from windows
application forms. These forms may be
over time, and may be addictive. When stopping
• Wear tinted lenses
obtained directly from Social Security or fil ed
As a rule, patients who receive treatment only
these drugs, under a doctor's supervision, they
• Place warm or cold compresses on the eyes
for blepharospasm do not develop antibodies.
must be tapered off and not stopped abruptly.
• Use sensory tricks (talk, sing or hum, touch
Is botulinum toxin treatment covered by Medicare
What are the names of drugs that may help
temple or forehead)
and medical insurance?
benign essential blepharospasm?
• Concentrate on a hobby or non-stressful activity
Lecithin Microemulsion Based Systems for Dermal Delivery of Drugs: A S. Khode, M. Lalan* Department of Pharmaceutics, Babaria Institute of Pharmacy, Vadodara, Gujarat, India. ABSTRACT The purpose of this review is to give an insight into the considerable potential of lecithin based nanocarriers. The lecithin microemulsion and closely related microemulsion based systems are currently of interest to pharmaceutical researchers. Conventional systems for topical delivery of drugs meet many hindrances like reduced permeation and entrapment efficiency. Lecithin nanocarriers with their enhanced bioavailability of drugs present a viable option to address the drawbacks of conventional formulations. Soya and egg lecithin are widely being explored. However, the purity of lecithin plays a significant role in gelation process. The review encompasses lecithin microemulsions, lecithin based microemulsion gels, pluronic lecithin gels and lecithin stabilized microemulsion based hyrogels in improving the topical delivery of drugs. Biocompatible lecithin based systems are known to furnish ways of many promising discoveries in the field of safe and efficacious topical dosage forms. Keywords: Microemulsion, Organogel, Pluronic lecithin organogel, lecithin
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